Publications by authors named "Yogesh Acharya"

23 Publications

  • Page 1 of 1

Discovering symptom patterns of COVID-19 patients using association rule mining.

Comput Biol Med 2021 04 1;131:104249. Epub 2021 Feb 1.

Data Science Institute, Insight Centre for Data Analytics, National University of Ireland Galway, Ireland. Electronic address:

Background: The COVID-19 pandemic is a significant public health crisis that is hitting hard on people's health, well-being, and freedom of movement, and affecting the global economy. Scientists worldwide are competing to develop therapeutics and vaccines; currently, three drugs and two vaccine candidates have been given emergency authorization use. However, there are still questions of efficacy with regard to specific subgroups of patients and the vaccine's scalability to the general public. Under such circumstances, understanding COVID-19 symptoms is vital in initial triage; it is crucial to distinguish the severity of cases for effective management and treatment. This study aimed to discover symptom patterns and overall symptom rules, including rules disaggregated by age, sex, chronic condition, and mortality status, among COVID-19 patients.

Methods: This study was a retrospective analysis of COVID-19 patient data made available online by the Wolfram Data Repository through May 27, 2020. We applied a widely used rule-based machine learning technique called association rule mining to identify frequent symptoms and define patterns in the rules discovered.

Result: In total, 1,560 patients with COVID-19 were included in the study, with a median age of 52 years. The most frequently occurring symptom was fever (67%), followed by cough (37%), malaise/body soreness (11%), pneumonia (11%), and sore throat (8%). Myocardial infarction, heart failure, and renal disease were present in less than 1% of patients. The top ten significant symptom rules (out of 71 generated) showed cough, septic shock, and respiratory distress syndrome as frequent consequents. If a patient had a breathing problem and sputum production, then, there was higher confidence of that patient having a cough; if cardiac disease, renal disease, or pneumonia was present, then there was a higher confidence of septic shock or respiratory distress syndrome. Symptom rules differed between younger and older patients and between male and female patients. Patients who had chronic conditions or died of COVID-19 had more severe symptom rules than those patients who did not have chronic conditions or survived of COVID-19. Concerning chronic condition rules among 147 patients, if a patient had diabetes, prerenal azotemia, and coronary bypass surgery, there was a certainty of hypertension.

Conclusion: The most frequently reported symptoms in patients with COVID-19 were fever, cough, pneumonia, and sore throat; while 1% had severe symptoms, such as septic shock, respiratory distress syndrome, and respiratory failure. Symptom rules differed by age and sex. Patients with chronic disease and patients who died of COVID-19 had severe symptom rules more specifically, cardiovascular-related symptoms accompanied by pneumonia, fever, and cough as consequents.
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http://dx.doi.org/10.1016/j.compbiomed.2021.104249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966840PMC
April 2021

Why Are Medical Device Multinationals Choking Disruptive Technology and Killing Innovation? Challenges to Innovation in Medical Device Technology.

J Endovasc Ther 2021 Jan 29:1526602821989356. Epub 2021 Jan 29.

Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Affiliated Hospital of the Royal College of Surgeons in Ireland and the National University of Ireland, Doughiska Galway, Ireland.

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http://dx.doi.org/10.1177/1526602821989356DOI Listing
January 2021

Sodium-Glucose Cotransporter Inhibitors in Non- Diabetic Heart Failure: A Narrative Review.

Cardiovasc Hematol Disord Drug Targets 2020 Dec 31. Epub 2020 Dec 31.

Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, EL Paso, Texas;. United States.

Background: Heart failure (HF) is one of the leading public health problems with a substantial burden in the global healthcare system. Although significant efforts are based on prevention, early recognition, and proper management of HF, the worldwide surge of risk factors like hypertension, diabetes, obesity has further complicated the existing problem.

Objective: To define the role of the sodium-glucose cotransporter 2 (SGLT2) inhibitors in non-diabetic HF.

Methods: We performed a comprehensive literature review to examine the available evidence in the clinical implications of SGLT2 inhibitors in non-diabetic HF using the online databases (PubMed and Embase).

Results: We identified two RCTs - DAPA-HF and DEFINE-HF, which were conducted to analyze the net clinical benefit of dapagliflozin in non-diabetic HF patients. Although we could not study the composite effects of these studies due to the difference in outcome measures, the individual outcomes look promising. The number needed to treat (NNT) to prevent one primary event was 21 (95% CI: 15 to 38) in the DAPA study. In, DEFINE HF study, responder analysis showed a significant proportion of patients in the treatment arm experienced improvements in functional status with clinically meaningful improvement in KCCQ-OS by 3.7 points and KCCQ-CS by 4.6 points with NNT of 10 and 7 respectively, at 12 weeks. Both studies also showed low safety concerns in patients without T2D.

Conclusions: The outcomes of the two RCTs, DAPA-HF and DEFINE-HF, that studied the effects of SGLT2 inhibitors in non-diabetic HF showed promising clinical outcomes. Although we are waiting for other prospective RCTs to reflect similar results and safety profiles, it seems the SGLT2 inhibitors can have broader clinical implications in managing non-diabetic HF with improved cardiovascular outcomes.
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http://dx.doi.org/10.2174/1871529X20999201231205504DOI Listing
December 2020

Management of Concealed Type IV Endoleak and Aortic Sac Hygroma by Prone ContrASt EnHancement Computed Tomography Angiography.

Ann Vasc Surg 2020 Dec 30. Epub 2020 Dec 30.

Department of Vascular and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland Affiliated Hospitals, Galway, Ireland.

Background: Aortic sac hygroma and concealed endoleaks (EL) after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm needs particular attention with aggressive management as they are associated with rapid sac expansion and rupture risk. However, they can be erroneously reported as type IV or V EL with supine computed tomography (CT) scans, leading to delay in management. Therefore, we describe a novel diagnostic technique, 'Prone contrASt enHanced computed tomography Angiography' (PASHA), to document concealed EL METHODS: We present eight case descriptions with continuous sac expansion after primary EVAR. Management began with diagnosis using the PASHA imaging technique. PASHA is a multiphase CTA positional technique for increasing the accuracy of detecting EL after EVAR. Furthermore, the PASHA imaging technique also guides whether the open or endovascular intervention could be used effectively to manage the sac expansion. In synchrony with the PASHA technique, "EVAR GORE SalvAge FAbric Technique" (ARAFAT) was to salvage previous EVAR.

Results: The PASHA technique diagnosed all cases of type IIIb EL, as it enhanced the degree of contrast infiltration into the aortic sac when microleaks were present. ARAFAT was effectively used in five elderly patients. Another three had an open conversion; two with double breasting of the aortic sac and one EVAR explantation.

Conclusions: The PASHA protocol helped classify and localize the concealed EL (type IV, V), which were not appropriately diagnosed by supine CT protocols. PASHA and ARAFAT were used as a fully functioning protocol to overcome apparent challenges in accurate diagnosis and subsequent concealed EL management in high-risk patients.
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http://dx.doi.org/10.1016/j.avsg.2020.11.039DOI Listing
December 2020

Outcomes of Unibody Bifurcated Endograft and Aortobifemoral Bypass for Aortoiliac Occlusive Disease.

Vasc Specialist Int 2020 Dec;36(4):216-223

Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland.

Purpose: We compared the outcomes between the total endovascular approach using a unibody bifurcated aortoiliac endograft and the gold standard aortobifemoral bypass (ABF) surgery for the management of extensive aortoiliac occlusive disease (AIOD).

Materials And Methods: This retrospective observational study compared the outcomes of endovascular technique with unibody bifurcated endograft (UBE) using the Endologix AFX unibody stent-graft and a standard surgical approach (ABF) in the management of AIOD based on patient records in Western Vascular Institute, Galway University Hospital, National University of Ireland. Procedural details and outcomes were documented to compare both groups.

Results: From January 2002 to December 2018, 67 patients underwent AIOD (20 UBE and 47 ABF). Both the ABF and UBE groups showed 100% immediate clinical and technical successes without 30-day mortality. There were no statistical differences in the overall survival and sustained clinical improvement between the bypass and the UBE groups; however, statistically significant differences were observed in 3-year freedom from re-intervention and amputation-free survival. Furthermore, the mean length of the intensive care unit (ICU) stay was significantly lower in the UBE group than that in the ABF group (0.75 days vs. 3.1 days, P=0.001).

Conclusion: Total endovascular reconstruction of AIOD is an alternative to invasive bypass procedures, with a shorter ICU stay.
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http://dx.doi.org/10.5758/vsi.200051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790696PMC
December 2020

Challenges in diagnosing aortic leiomyosarcoma post endovascular repair of abdominal aortic aneurysm.

J Vasc Surg Cases Innov Tech 2020 Dec 2;6(4):666-670. Epub 2020 Sep 2.

Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland Galway Affiliated Hospital, Galway, Ireland.

Primary aortic tumors after endovascular aortic repair are rarely reported in the literature. Here, we report an elderly male with abdominal aortic leiomyosarcomas (LMS) after an endovascular aneurysm repair in 2012 for a 5-cm symptomatic abdominal aortic aneurysm using an Endurant II aortic stent graft (Medtronic, Minneapolis, Minn). The autopsy confirmed the aortic LMS after the patient rapidly deteriorated and succumbed to death. The vascular LMS are rapidly progressive and diagnostically challenging malignant soft tissue tumors with poor prognosis, which necessitates a strong clinical suspicion and attentiveness to radiologic signs for prompt diagnosis.
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http://dx.doi.org/10.1016/j.jvscit.2020.08.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683213PMC
December 2020

Gender Disaggregation in COVID-19 and Increased Male Susceptibility.

J Nepal Health Res Counc 2020 Nov 13;18(3):345-350. Epub 2020 Nov 13.

Cecil G Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, USA.

Novel coronavirus disease 2019 (COVID-19) is a growing public health crisis. Despite initial focus on the elderly population with comorbidities, it seems that large studies from the worst affected countries follow a sex-disaggregation pattern. Analysis of available data showed marked variations in reported cases between males and females among different countries with higher mortality in males.  At this early stage of the pandemic, medical datasets at the individual level are not available; therefore, it is challenging to conclude how different factors have impacted COVID-19 susceptibility. Thus, in the absence of patients' level data, we attempted to provide a theoretical description of how other determinants have affected COVID-19 susceptibility in males compared to females.  In this article, we have identified and discussed possible biological and behavioral factors that could be responsible for the increased male susceptibility. Biological factors include - an absence of X-chromosomes (a powerhouse for immune-related genes), a high level of testosterone that inhibits antibody production, and the presence of Angiotensin-converting enzyme 2 (ACE2) receptors that facilitate viral replication. Similarly, behavioral factors constitute - higher smoking and alcohol consumptions, low level of handwashing practices, and high-risk behavior like non-adherence to health services and reluctance to follow public health measures in males. Keywords: COVID-19; gender; males; sex disaggregation; susceptibility.
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http://dx.doi.org/10.33314/jnhrc.v18i3.3108DOI Listing
November 2020

A pilot protocol and review of triple neuroprotection with targeted hypothermia, controlled induced hypertension, and barbiturate infusion during emergency carotid endarterectomy for acute stroke after failed tPA or beyond 24-hour window of opportunity.

Ann Transl Med 2020 Oct;8(19):1275

Department of Vascular & Endovascular Surgery, Galway Clinic, Royal College of Surgeons of Ireland/National University of Ireland Affiliated Teaching Hospitals, Doughiska, Galway, Ireland.

An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in ischemic stroke management. As tPA is time-dependent, delays can occur in definitive treatment while passively waiting to observe a clinical response to intravenous thrombolysis. Until today, uncertainty exists in the management strategy of wake-up stroke patients or those presenting beyond the therapeutic tPA window. Clinical dilemmas in these situations can prolong the transitional period of inertia, resulting in an adverse neurological outcome. We propose and review an innovative approach called triple neuro-protection (TNP), which encompasses three technical domains-targeted hypothermia, systemic induced hypertension, and barbiturates infusion, to protect the brain during carotid endarterectomy after failed tPA and/or beyond the 24-hour therapeutic mechanical thrombectomy window. This proposal assimilates discussion on the clinical evidence of the individual domains of TNP with our own clinical experience with TNP. Our first TNP was successfully employed in a 55-year-old man in 2015 while performing emergency carotid endarterectomy after he was referred to us 72 hours post tPA failure. The patient had a successful clinical outcome despite being in therapeutic inertia with 90-99% ipsilateral carotid stenosis and contralateral occlusion on presentation. In the last five years, we have safely used TNP in 25 selected cases with favourable clinical outcomes.
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http://dx.doi.org/10.21037/atm-2020-cass-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607101PMC
October 2020

Convalescent Blood Products in COVID-19: A Narrative Review.

Ther Adv Infect Dis 2020 Jan-Dec;7:2049936120960646. Epub 2020 Sep 22.

Research Fellow, Vascular and Endovascular Department, Western Vascular Institute, National University of Ireland, Galway, Ireland.

The coronavirus disease 2019 (COVID-19) pandemic has left the world in a state of desolation with overburdening public health systems in a short period. Finding possible preventative and therapeutic measures to counter severe respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has been the priority. A possible solution is convalescent blood products (CBP), primarily convalescent plasma (CP) and immunoglobulins, as an adjunctive therapy. CBP has been tried on the previous coronavirus epidemics with severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Therefore, we reviewed the clinical utility of CBP and available evidence in COVID-19. We found some of the current anecdotal studies demonstrate promising therapeutic potential, but many of these studies do not meet the academic rigours to substantiate its use with confidence. However, the compassionate use of CBP in critically ill COVID-19 patients can be an option while we await a definitive answer from ongoing randomised clinical trials.
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http://dx.doi.org/10.1177/2049936120960646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513012PMC
September 2020

Eikenella Corrodens Vertebral Osteomyelitis in a Young Patient With Type I Diabetes Mellitus.

Cureus 2020 Aug 4;12(8):e9553. Epub 2020 Aug 4.

Vascular and Endovascular Surgery, Western Vascular Institute, Galway, IRL.

Vertebral osteomyelitis is an uncommon variant of osteomyelitis. Although and/or are commonly associated, alternate pathogens have been implicated in vertebral osteomyelitis, especially in endemic areas and/or immunocompromised patients. Here, we present a case of a young African American female with type I diabetes mellitus who presented to us with worsening back pain. The MRI lumbar spine was suggestive of vertebral osteomyelitis involving the right facet joint of the fifth lumbar (L5) and the first spinal (S1) joint and a significant narrowing of the thecal sac at the L4-L5 vertebral level with an anterior epidural abscess. The patient was started on empirical antibiotics, and surgical intervention was performed with L4-L5 laminectomy and extraction of the epidural abscess. Her pus culture showed as a possible cause of vertebral osteomyelitis. She had an uneventful recovery after two weeks of antibiotics (intravenous ceftriaxone) therapy.
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http://dx.doi.org/10.7759/cureus.9553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470658PMC
August 2020

Commentary: When Promising Innovators Lack Strategic Vision: The Concept of Flow Modulation in Aortic Dissection.

J Endovasc Ther 2021 02 1;28(1):32-35. Epub 2020 Sep 1.

Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland, and National University of Ireland, Galway Affiliated Hospital, Galway, Ireland.

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http://dx.doi.org/10.1177/1526602820954450DOI Listing
February 2021

Chloroquine and hydroxychloroquine as a repurposed agent against COVID-19: a narrative review.

Ther Adv Infect Dis 2020 Jan-Dec;7:2049936120947517. Epub 2020 Aug 4.

Medicine Department, Avalon University School of Medicine, Willemstad, Curacao, Netherlands Antilles.

The predicament arising from the coronavirus disease 2019 (COVID-19) pandemic has become one of the most significant modern public health challenges. Despite uncertainties in the viral determinants and pathogenesis, it is crucial to accurately inspect all available evidence to construct accurate clinical guidelines for optimised patient care. This study aims to discuss the available evidence for the use of chloroquine (CQ) and hydroxychloroquine (HCQ) against COVID-19. Early studies of CQ/HCQ against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are convincing. But contradictory evidence exists on the clinical use of CQ/HCQ, either alone or in combination with azithromycin. As of now, there is no compelling clinical evidence on CQ, HCQ, and azithromycin in COVID-19 and the available evidence is limited to methodologically inferior non-randomised studies. Studies have also shown detrimental drug reactions to CQ and 'HCQ plus azithromycin', mainly cardiac side effects in hospitalised patients with coexisting cardiovascular comorbidities. Therefore, we recommend that physicians avoid high doses and exercise extreme caution in the compassionate use of CQ/HCQ, either alone or in combination with other antiviral drugs.
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http://dx.doi.org/10.1177/2049936120947517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404096PMC
August 2020

New-Onset Seizure as the Only Presentation in a Child With COVID-19.

Cureus 2020 Jun 25;12(6):e8820. Epub 2020 Jun 25.

Vascular and Endovascular Surgery, Western Vascular Institute, Galway, IRL.

We present a child with a new-onset isolated afebrile seizure in coronavirus disease 2019 (COVID-19). This patient, an 11-year-old Hispanic male, was brought to our ED in New York city on May 01, 2020, during the ongoing COVID-19 crisis with seizure. There was no fever and/or respiratory and gastrointestinal complaints. His general and systemic examination did not reveal any abnormality. Similarly, his biochemical profiles were within normal limits, and the radiological study, including a chest X-ray and CT scan, showed normal findings. His polymerase chain reaction (PCR) was positive for SARS-CoV2. The patient was admitted for observation after consultation with pediatric neurology, and his condition progressively improved with anti-seizure medications. This case highlights the need for recognizing an uncommon and atypical presentation in COVID-19 as the new cases are unfolding rapidly across the globe.
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http://dx.doi.org/10.7759/cureus.8820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384710PMC
June 2020

Antimalarial and cytotoxic drugs on COVID-19 and the cardiovascular burden: Literature review and lessons to be learned.

Vascular 2021 Apr 21;29(2):220-227. Epub 2020 Jul 21.

Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland.

Background: The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-19). It is important to accurately analyze the available evidence to provide correct clinical guidance for optimal patient care. We aim to discuss current clinical evidence regarding chloroquine, hydroxychloroquine, azithromycin, remdesivir, and the cardiovascular burden of COVID-19.

Methods: A literature review was performed using PubMed and Google Scholar. Additional clinical trials were identified through the "TrialsTracker" project.

Results: We found conflicting evidence of chloroquine, hydroxychloroquine plus azithromycin, and remdesivir in COVID-19 despite promising early reports of in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2. Some of the current studies have demonstrated adverse drug reactions to chloroquine and hydroxychloroquine + azithromycin. Widespread systemic inflammation and procoagulant/hypercoagulable state, including thrombotic microangiopathy, endothelial dysfunction, bleeding disorder, and thrombosis are increasingly being witnessed in COVID-19. Evidence of cardiac injury and stroke is mostly reported in hospitalized patients; however, large specialized studies that focus on cardiac or neuropathology are lacking.

Discussion: There is no convincing clinical evidence of chloroquine, hydroxychloroquine with or without azithromycin, and remdesivir use in COVID-19. As evidence of systemic inflammation is rapidly unfolding, there is a dire need to maximize our resources to find the best possible solutions to the current crisis while conclusive evidence from clinical trials emerges.
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http://dx.doi.org/10.1177/1708538120941635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375357PMC
April 2021

Isolated Chromosome 6q27 Terminal Deletion Syndrome.

Cureus 2020 May 13;12(5):e8103. Epub 2020 May 13.

Vascular and Endovascular Surgery, Western Vascular Institute, Galway, IRL.

Any change in either the short (p) or long (q) arm of chromosome six can result in a variety of disorders.  A two-year-old female child came to us with a history of sudden onset generalized tonic-clonic seizure. She had a syndromic face with frontal bossing and palpable thinning of the right lower lip and an apparent facial asymmetry while crying due to the hypoplasia of the right depressor angularis oris. Her joints were hypermobile and hypotonic. Chromosomal karyotyping exhibited a normal female karyotype, but pathogenic microarray genetic evaluation showed a loss of approximately 783 kb of the 6q27 terminus. She was diagnosed with chromosome 6q27 terminal deletion and managed with anti-seizure medications.  Chromosome 6q27 terminal deletion can present with an array of structural and developmental anomalies. It is, therefore, necessary to understand the typical phenotypic and distinctive clinical features of congenital chromosome 6q27 terminal deletion syndrome for early diagnosis and intervention.
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http://dx.doi.org/10.7759/cureus.8103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292719PMC
May 2020

Unusual case of lower back pain-piriformis myositis: a case report and literature review.

Pan Afr Med J 2019 3;32. Epub 2019 Jan 3.

Trauma and Orthopedics Department, Our Lady of Lourdes Hospital, Drogheda, Republic of Ireland.

We present a case of a 37-year-old male security officer with fever, severe low back pain radiating to left lower leg and diminished mobility for 1 week. His Lumbar spine X-ray was unremarkable, but his inflammatory markers including CRP, ESR and Neutrophils were high. CT scan with contrast showed rim enhancing fluid collection within the left obturator foramen with inflammatory change in the mesorectal fat. Confirmatory MRI scans depicted inflammatory change in the left piriformis muscle and a localized collection without any abnormality in the spine. Urgent CT guided aspiration was performed and the sample sent for microbiological analysis. Intravenous antibiotics commenced and continued for two weeks with complete resolution.
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http://dx.doi.org/10.11604/pamj.2019.32.4.17808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536294PMC
June 2019

Regulation of Surgical Procedures and Health Care Facilities Rankings in Nepal.

JNMA J Nepal Med Assoc 2019 Jan-Feb;57(215):64-66

Saint Peters University Hospital, New Jersey, USA.

Globally, millions of surgeries are performed each year to compliment and manage a diverse set of medical conditions. Adverse surgical outcomes constitute a major proportion of avoidable death and disabilities in the hospital, especially in low-income countries like Nepal. A comprehensive study on the standards of surgical procedures and its institutional regulations is missing. We discuss here the importance of surgical regulation based on it's financial as well as healthcare implications in the Nepalese healthcare system. Keywords: health care facilities; safety; surgery; surgical procedures; WHO.
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November 2019

Challenges of New Healthcare Reform Act 2017 and Possible Rise of Defensive Medicine in Nepal.

J Nepal Health Res Counc 2018 Oct 30;16(3):357-358. Epub 2018 Oct 30.

Saint Peters University Hospital, New Jersey, USA.

Hippocratic oath, written 4th or 5th century BC, is still the binding mantra for physicians, which swears to fulfill to the best of one's ability and judgement, and treat sick human beings not just illness. But with changing health trends in southeast Asia region, there is a dramatic shift in patients and patients' party expectations regarding treatment, recovery, complications, and death. Such expectations havelead to violence against physicians and shift towards alternative medical practice. This article explores the possible rise of defensive medicine and its broader implications in health care system in Nepal with regard to the new 'Muluki Aparadh Samhita Ain 2074/Criminal (Code) Act 2017'. Keywords: Changing health; criminal act; defensive medicine; muluki ain, Nepal.
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October 2018

Implementation of standardized patient program using local resources in Avalon School of Medicine.

J Adv Med Educ Prof 2018 Jul;6(3):137-141

Avalon University School of Medicine (AUSOM), Willemstad, Curacao, Netherland Antilles.

Introduction: The standardized Patient Program (SPP) is a standard educational training method which provides the pre-clinical students a better clinical foundation by linking the realm of clinical medicine to basic sciences. It incorporates a modern simulation technique and enhances the ability of the students wherein they can practice, apply and learn the basics of patient encounter. The main objective of this study was to analyze the implementation and efficiency of the SPP in Avalon University School of Medicine (AUSOM).

Methods: A quasi-experimental "before-and-after" study design was conducted among the 3rd Semester (MD3) medical students at AUSOM. 24 students voluntarily participated in the study. The effectiveness of the program was evaluated after comparing the summative examination scores before and after implementation of the SPP (graded in 100 points system). Mean scores were calculated and a comparison of the change in scores was made, using a paired t-test in Stata (ÓStata corp).

Results: The mean final summative clinical skills examination scores of the students before and after the introduction of the SPP were 78.46 ± 6.62 (SEM: 1.35, range: 89-70) and 86.54±6.41 (SEM: 1.31, range: 98-65), respectively. There was a statistically significant increment (t=5.5058, p=0.0001) in the scores of the students after the introduction of the SPP.

Conclusion: Introduction and implementation of SPP at AUSOM at preclinical years increased the overall students' performance in clinical skills. It is necessary that medical schools implement SPP early in preclinical years to strengthen learning and inoculate necessary clinical skills in medical students.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039824PMC
July 2018

Integrated curriculum and the change process in undergraduate medical education.

Med Teach 2018 05 13;40(5):437-442. Epub 2018 Mar 13.

a Avalon University School of Medicine (AUSOM) , Willemstad , Curaçao.

Introduction: This study is aimed at explaining the change process followed for the implementation of the new curriculum at Avalon University School of Medicine and its evaluation.

Background: Self-evaluation at Avalon University School of Medicine identified the need for a change in the curriculum. The main reasons for the change are isolated disciplines and overcrowded curriculum leading to less self-study time for students. The new curriculum is aimed to have an integrated curriculum and to avoid redundancies. The new curriculum is designed, implemented, and evaluation of the same is in place. Evaluation methods and materials: After implementation, quantitative (results from exams) and semi-quantitative (self-administered questionnaire) evaluation methods are being used to evaluate the new curriculum. Feedback is also taken by having discussions with teachers and students to find out what they like and where modifications are needed. In this article, we are presenting the results of course evaluations (semi-quantitative methods) for two courses. The course evaluations were taken from the sample class size of 30 students.

Results And Discussion: The course evaluations demonstrated an improvement. The main reason for the improvement is due to collaborative efforts of the faculty members from different disciplines in teaching, assessments, and providing feedback to the students.

Conclusions: The well-approached change process is required for the successful implementation of the new curriculum. The idea of ownership among all stakeholders is required for a well-managed change process.
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http://dx.doi.org/10.1080/0142159X.2018.1441988DOI Listing
May 2018

Fungal keratitis: study of increasing trend and common determinants.

Nepal J Epidemiol 2017 Jun 30;7(2):685-693. Epub 2017 Jun 30.

Medical officer, Nobel Medical College and Hospital, Biratnagar Morang, Nepal.

Fungal keratitis is one of the leading cause of ocular morbidity. Fungal keratitis possesses a clinical challenge due to its slow pathologic process, overlapping features, diagnostic difficulty, and potential complications. Its increasing trend can be attributed to the use of contact lens, non-judiciary corticosteroid, and vegetative trauma. Early diagnosis and treatment is the cornerstone for its effective control. Knowledge of pathological course and clinical characteristics of fungal keratitis will definitely add in early diagnosis and treatment, with reduction in ocular morbidity. This review article explores the risk factor of fungal keratitis, its clinical course and management strategy.
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http://dx.doi.org/10.3126/nje.v7i2.17975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673246PMC
June 2017

Evidence-based medicine in pre-clinical years: a study of early introduction and usefulness.

J Adv Med Educ Prof 2017 Jul;5(3):95-100

Department of Administration, Avalon University School of Medicine, Curacao, Netherlands.

Introduction: Evidence Based Medicine (EBM) has established itself as a strong predictor of future medical practice by medical students. The purpose of this study was to determine the effectiveness of EBM in pre-clinical years and reflect on self-assessment skill of 4 semester medical students regarding the understanding of EBM and its various determinants.

Methods: All of the 4 semester (MD4) medical students at the Avalon University of Medical School, Curacao who had completed their EBM curriculum were asked to voluntarily participate in a cross sectional student survey containing qualitative and quantitative questionnaires in a 10-point scale. The students' responses were analyzed statistically and the results reported.

Results: Twenty-three students participated in the survey. 91% of them reported that EBM had helped them to better understand research process and 95% believed that EBM was necessary to develop clinical skills in the future. 78% of the students agreed that they were provided with enough resources for effective implementation of EBM in the university. All participants (100%) self reported that they could appraise the research articles effectively (mean score 8.26, S.D-1.45).

Conclusions: EBM is an integrative and comprehensive way to successfully adopt concepts of acquired medical knowledge for effective medical practice. Early introduction of EBM in preclinical years proved favorable in students and better equipped them with the ability to critically apprehend and appraise new research and innovations in medicine for optimal learning experience. There is a definitive need for scientific and systematic design of the curriculum for early introduction of EBM in pre-clinical years, best suited for the students. The principles should be directed towards further research for the effective implementation of EBM to enhance clinical skills.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522909PMC
July 2017